i freakin’ did it! :) 480!

In this blog

  • i freakin’ did it! – 480
  • humble pie
  • future plans

i freakin’ did it!

I guess there’s a story here but there also is much I’d rather not admit to.  The number of times it took me to finally pass my Part III board exam is one thing I’d rather not advertise.  I wish I could say “third times a charm!”  but … it was more like 5 times and possibly 6.

I hone in on my brother who didn’t even attempt Part III until after he graduated because he failed it on his first attempt but passed it on his second attempt.  So, if you don’t count all the attempts prior to graduation then, at least, I was able to emulate him.

Age is another matter I don’t really want to own up to so….hypothetically speaking ….it’s like I started this new adventure when I was still 41 years old and, after I get results for my Part IV exam which I’ll be taking in May of 2015 I …could be ,,,49.

Then things become a little surreal.  Have I actually spent a decade of my life in this pursuit? 20-25% …  and this is all post college.   As my brother described it before I started my attempt to become a DC, he said it was “balls to the wall” and, that may even be an understatement.

Humble Pie – sort of fits in with all this since I just finished up a week of reviews in preparation for my May 2015 exam.  Within minutes of the first day of reviews you realize you’re eating humble pie – within the first hour, you realize it’s more like a humble buffet that’s being forced down your throat.

The questions are rapid fire, like a machine gun.  Is body temperature increased or decreased with Graves disease?  Temperature?  Don’t we have a lab panel to look at?  I never thought of a simple vital sign pointing me in the direction of Graves disease, I think of exophthalmos – eyes bulging out, increased T3, 4, TSH …oh, OK, hyperthyroidism, I guess it would make sense that we’d have an increased temp but, by the time my 10-speed brain figures all that out I’m 3 questions behind and we’re talking about Thalassemia – …I just studied some anemias the other day, maybe I can feel a bit smug as opposed to stupid …not a chance.  I’m confusing Coombs (a test for Rh factor with Cooley’s Anemia which is a subset of Thalassemia.  Now I’m falling farther behind, feeling stupid, wondering if I even belong there.  It’s a trip – that much is certain.

That’s pretty much how the days go, from 9 a.m. to 6 p.m. save an hour for lunch.  We covered 2 years worth of radiology in a day and a half this past weekend.  At which point, I’m thinking the words ‘self torture’ and really don’t want to go back for any more.

Mock exams are Monday, the 27th of October – gotta show up for that.  These upcoming Part IV exams – one day is all radiology, the other consist of 25 different rooms filled with actors pretending to be patients with certain diseases.  We get a whole 5 minutes per room to ask questions and test accordingly after which time we move to another room and have 90 seconds to look over x-rays and lab results then need to come up with a diagnosis, differential dx, and appropriate case management & treatment.  I guess it’s not so bad but, this goes on for 3 hours straight.

The DC program is kind of like signing up for a slow death and you just need to graduate before it kills you.  And, other than the 20% or so that don’t make it to graduation after 15 semesters a few do die.  I remember one guy died from a heart attack one weekend when I was at school because, you know, 8 hours of classes along with clinic during the weekdays is never enough and the stress is very real.

The most self induced stressful times I’ve had this year have been at those reviews.  That’s when I’m reminded that we actually have three autonomic nervous systems.  Most everyone knows about the good old, fight or flight – that’s the sympathetic nervous system and is sort of like the bodies gas pedal.  Somewhat lesser known would be our parasympathetic nervous system which would be like our brakes or some say ‘wine & dine’ or even …poop & relax.  Probably the least well known autonomic nervous system would be our enteric nervous system which is made up of two subsets known as Aurebach’s and Meissner’s plexuses.  This system basically has to do with our gut.  and – without exception that’s where I feel a great deal of stress making itself known but, it also helps me make greater sense of various ailments such as enteropathic arthropathies and remembering to ask patients about various work and social aspects of their life to help gauge levels of stress in their lives.

March of this year was my first post graduation attempt at Part III and I failed it worse than any other time I attempted the exam with a very dismal score of 340.   A score of 375 is needed to pass Part III.  I did learn that we needed to have everything from Part II down cold and wholly memorized as a prerequisite for getting through Part III so I scheduled review sessions for Parts II, III and even a few PT reviews this past August.  Essentially 23 solid days of reviews in 3 different states – Iowa, Kansas and Missouri and averaged about 12 hours a day of worthwhile study.

Well – it freakin’ paid off!  A few days ago I checked to see when the scores might be available and to my surprise the website said results would be available Monday morning, 8 a.m. MST.

I crushed it!  Bested my previous score by 140 points and ended up getting a 480!

2014-10-27 14.11.43

There was a week between my last review session and that exam and that week was probably unduly stressful because I had to work every day leading up tot he exam – my fault,  for not requesting more days off but, I had already taken off nearly a month – still, I’d done enough to pass with flying colors! 🙂

In order to finally get though school, I had to break things up by first finishing all my classes then I focused exclusively on completing my clinics.  That strategy did work and got me to graduation.  However, a lot of the kids I talked with during this past week shared with me that they were in the process of finishing up their 2nd year of radiology with me – I have to go back about 3 years to when I finished and I realize, every day that passes between when all these classes ended and now all tends to make that humble buffet a little bigger every single day.

On the other hand, maybe it’s a bit like that Leitner method of memorization with spaced repetition and perhaps I can at least say I’m on my way to eventually consuming, digesting and assimilating that humble buffet.

I’ve got about 6 months before that exam.  I just need to up my game.

oh yeah – one of the last hotels I stayed at when prepping for my Part III retake didn’t have a desk, it barely had room for the bed so I spent a lot of time outside with a book and leaning on the balcony.  I spent so much time with my elbows on that balcony holding my books that I eventually wore the skin away on my elbows to the point of bleeding.  Study battle scares!  Good for the male ego and kind of funny.  About a week later my brother took a picture

2014-08-28 01.15.46 - Copy

well, not overly dramatic but, if you look closely you can still see the study scars 😉

Honestly, it was pretty emotional to see that score.  Anyway, I suppose that’s enough musing.

Time to look forward – There is one state in the country that allows you to get a license with Part III and that state is Illinois where I happen to live 🙂

and, with that license I can finally apply to test and become an NRCME! – Nationally Registered Certified Medical Examiner.

How long does it take to get a license…. (had to Google this)  looks like once I tic off 15 or so items the state requires and get everything sent in then I should have it within about 2 and a half months.  ….hmmmm, maybe by Valentines Day 🙂

Pondering 2015 – real possibilities include that license and a black belt in karate.  I think I’m signed up for 3 half marathons – 2 in April and one Rock n Roll in October.

I did play it a little smart and allocated some post-review time at my parents condo so I’ll have some time to get some plans in motion and figure out more for 2015 and, ideally not end up as sick and strung out on stress like I was after my last bout of reviews.

I did learn on that site I Googled that only 150 hours of CMEs (Continuing Medical Education) is needed each year, I thought it was 200 hours.  This will afford me some great opportunities.  I think one of the first things I’d like to go after is a diplomat (specialty) in Neurology.  A first step there will be searching out a former teacher by the name of Dr Bub!  🙂

 

 

 

 

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Week 22 Day 2 – 1.2 Miles

My running weeks run Monday through Sunday so I still had a chance, as of yesterday, to still fit in 4 runs for this week.  Unfortunately an unexpected rain shower and my gym being closed put an end to that idea.

I did head out tonight and squeezed in a quick 1.2 miles.

2014-09-07 03.17.13

I’ll probably have a similar run tomorrow before work to give me three runs for the week then I’ll look to maintain the frequency for the final days leading up to my Part III exam.

I did 100 miles last month and in the last 8 days of the month I only ran twice so, tomorrow is the 7th day of Sept and I’ll be able to get in a third run.  I did have a 13.1 mile training run last month and a double run day for a total of 11.5 miles and one 8 mile day.  Other than those three runs there wasn’t anything much beyond a 10k.

It looks like Sports Tracker has upgraded it’s online website.  I like the new format.  It’s URL is listed as beta.sports-tracker.com  At the top of the dashboard is a chart showing my last 30 days worth of running with a total of 19 hours 44 minutes spent running and a distance of 82 miles.  Apparently, that’s down 9% from the previous 90 days.

Since it was raining last night I went grocery shopping and found an amazing deal on bottled water – only $1.99 for a 24 pack so I got 6 cases.  That should help put me back on track.

Basically, making sure to get in my runs, regardless of how short and shooting up a blog of each one will be about the extent of my running involvement for the rest of this week.  My mind is pretty well focused on that upcoming exam.

I’m pretty sure I’ll do much better than my previous attempts but don’t know for sure if I’ll pass.  If I don’t pass then I would think there would only be one or two areas out of the 9 areas we get tested on which would need more work.  I know I could maintain 7 or 8 areas and beef up whatever area might be left to pass for certain in March but, there is still a decent chance next week.  We’ll see.

Pass or fail, I still want to get through Part IV next May.  I’ll be darned – just checked the NBCE website and there’s only three major areas to be tested and one of them is actually (finally) chiropractic.

  • x-ray interpretation and diagnosis
  • chiropractic technique
  • case management

I was talking with an MD friend of mine about all these exams and he said his part four was for his specialty so, that would make sense that we finally have some actual chiropractic in this last exam.

I was looking at some Instagram running post and one person mentioned that “this shit sure takes a long time”  I would have to agree.  It certainly does with the running and I’m also thinking it sure takes a long time with the doctor road as well.

I got some literature again from St George’s University School of Medicine while I was away on my travels.  This is the medical school down in Grenada and, if anyone reading this is old enough to remember it’s a country the US invaded back in the early 80’s when Reagan was president.  From what I’ve learned that medical school in Grenada and the great many US students there played a factor in our invasion.  About all I really remember was seeing a picture of a long line of US helicopters making their way into the country and wondering how terrifying that must be if you’re someone on the ground.

It sure would be a beautiful place to stay for 4 years while getting a degree but I have no idea how the financial aspects of it would work.

That mailer prompted me to look into the situation a bit more.  Back in the 1970s there were three medical schools in the caribbean and as of 2011 there are now 60.

hmmmm – here is a picture of the beach at St George

1280px-Grand_Anse_Beach_Grenada

that’s a picture probably worth clicking on to make bigger ….it’s very alluring.

but – for now, I have to focus myself on getting this:

engraved_cert

 

I have a plaque just like that for completing the physiotherapy requirements for the NBCE.  With the plaque above I’ll be good to go for practice in any state in the Union and, a few other countries as well.

6 years post college – 1.5 years to finish up licensing – at least 1 year understudy working w/ someone else then after 5 years with my own office things should be looking pretty sweet.  At least, that’s the standard pattern I’ve seen many of my colleagues take.

 

Week 33 Weigh-In – Wooosh! Massive Weight Gains

I weighed myself yesterday morning, Thursday as I normally do and saw 260.8 lbs but, what really got my attention was stepping on the scale today – Week 33 plus 1 day and saw an all time high for the past 21 weeks of 267.4!  Hmmm.  Well, I added not only the official Thursday weight to my desktop wallpaper but also added  that 267.4 weight.

Week n - 2nd 12 Week Session Week 33

Basically in 3 weeks and 1 day I managed to gain over 20 pounds.  Of course, yesterday just ended 24 days of 9-5 board reviews so things may not be as bad as it first appears.  Perhaps more importantly, are the cars I’ve added to my Week 33 weigh in so, maybe we should address those first 😉   (it’s a guy thing)

968 Porsche
In the lower right hand corner we have the 968 Porsche which is a front engine, 4 cylinder car which was only produced from 1992 to 1995.  There were a little over 12,000 of them made and only about 2,400 which were convertibles.  This little car started it’s life as a 924 in the mid to late 70s, then grew up into the popular 944 model then ended with this amazingly refined 968.  Well ….I guess you could say the 914 may have been the oldest predecessor in this line of front engine Porsche cars.

I always have to wonder why any car enthusiast, especially a Porsche enthusiast would ever bother with a 944.  Those cars are a dime a dozen and have to wonder if they just don’t know the lineage of the car or maybe just want the cheapest option available and still be able to tout the Porsche name.

In a 500 mile search on cars.com of Porsches there’s 38 944s available with prices starting below $2,000 while the 968 yields only 2 for sale with a low price of $13k.

When I was 19 I bought a 924 and still remember quite a bit about it.   It was Alpine White, about 4.5 inches off the ground and had a 016z transmission which meant the transmission was in the back of the car and not directly mated to the engine.  This provided a nearly perfect 50/50 weight distribution.  The ergonomics of that car were still the best of any car I’ve ever owned or driven for that matter.

Had to check wikipedia for info on these models – sure enough – about 171,000 of the 944s were produced.  The much nicer 968 however only had 12,776 total produced and only 4,665 of them were distributed between the US and Canada.  Of those, 2,248 were convertibles that made it to the US.  Definitely not a dime a dozen car like the 944.

I have never owned a convertible before and the 968 cabriolet was going to be my first.  I was in the market for one prior to heading back to school and even had a spreadsheet where I kept track of the 968 cabriolets for sale, along with their VIN numbers since there were only so many of those cars in play.

2015 Corvette
My brother is on his 3rd ‘vette so I wanted to check them out.  $54,000 baseline coupe and $59,000 baseline price on the convertible.  I’m not sure if I’ll ever be buying one of these new – probably not but, it was fun to go through the Chevy “build your own” website.  0-60 in 3.8 seconds – that’s kind of like my motorcycle fast.

2015 Camaro
These start at $24,700 for the 1LS but, I would have to get a 1LT model (baseline $27,000) in order to get the optional 245 watt, 9 speaker Boston audio system.

Before I headed out on my 24 day board reviews trek I watched a number of car videos on YouTube including one that was about 1.5 hours long on the history of cars starting back with the steam driven vehicles up to current models and a glimpse into the future.

Another great thing about the 968 Porsche was that as early back as 1992 when it first came out it had variable cam timing – who else had that?  It was maybe 10 or 15 years later when I noticed the Honda Civic incorporated variable cam timing in their cars.

I’m not sure what the 968’s cost new but back in 2007 the resale value had dipped below $20k for most of them with lower mileage models going for just under $30k.   According to wiki, in April 2012 a 968 got auctioned off for $346,000.

What about running?  Week 33 Weigh-In and getting fatter??!
Yesterday concluded my 24 day marathon of reviews during which time I had only 2 days off and a ton of travelling.  I got home a bit early yesterday at 5:30 and around ….oh, 5:31 I was fast asleep.  Totally exhausted but, nothing 14 hours of sleep couldn’t fix 🙂  However, as much as weighing 260.8 caught my attention yesterday it was the 267.4 this morning which really caught my attention.

Pragmatically speaking, this new high weight has me a little concerned because I’m signed up for a 50 mile bike ride tomorrow – huh.

So, what happened?  I overlayed my weight for the past 4 weeks on my calendar.  Then I realized that these past 3+ weeks were much like when I was in clinic and school last year and watched my weight climb and climb week by week.

Basically, it seems anytime I’m sitting on my but for 9 or more hours per day with little or no days off that my weight goes up.

Things started easy in Davenport – almost ideal actually.  School was still in session in Iowa so my first four days of reviews were only from 5 to 11 p.m., just 6 hours of reviews each day and plenty of time to study and run and swim and I hit my low weight of 245.  But, after those four days, every day became 9 a.m. to 6 p.m. – everyday including weekends.

In Iowa and Kansas, I was at least able to stay in hotels that were close to the schools.  My final week in Chesterfield, MO meant staying at home and commuting every day so, in addition to the 9-6 schedule there was another 2 hours of driving each day so the schedule was more like 8 am. to 7 p.m.  Bedtime hovered around 9 p.m. so, that’s 11 hours per day on my butt and another 8 or so sleeping.  It’s an ideal situation for packing on the pounds fast and very stressful.

It’s either ironic or funny depending on how you look at this but, one of my 26 reasons for leaving SAVVIS to go back to school to become a chiropractor had to do with my health and health was probably a top 5 reason for making the change.  I grew to loathe the drive to SAVVIS everyday and figured I would move close to school and not make that drive everyday anymore.  I never did more and simply added 5 miles per day each way to my commute.

2007 was a big running year for me because I was trying to offset 5 years of sitting on my butt for 11 hours per day and the ensuing weight gain.

Well – I have to figure a few things out here –

It’s Friday and I went jogging Wednesday for 4 miles.  It was pretty rough.  I remembered way back in high school a book I read – it may have been a tape of the book called, “You can’t afford the Luxury of a negative thought”  A part of that book had you imagine that you were some kind of master achiever, that you could work towards anything you thought of and accomplish it then, achievement got too easy, lost it’s luster and you wanted a greater challenge so you created a button called “Greater Challenge” – pressed it and found yourself exactly where you are now.

For me, I realized that the extra hours of commuting along w/ the 9 hours of reviews and only 2 days off over the past 24 days was representing a greater challenge so I simply went to a park near the school and was able to get in 4 miles.  I had two days off before that and 3 days away from running before that.

But – my running weeks are Mon through Sunday so, I still have 3 days left for this 22nd week of my program and can get in 4 days of running this week as long as I go today, tomorrow and Sunday –

easy enough.  I don’t see myself doing 18 miles on Sat as scheduled, nor do I care a whole lot right now.  I’m not overly concerned about that 50 mile bike ride tomorrow either – and, it just occurred to me that bike ride did not have any online payment options so, I’m only registered and have not paid for it.  Cool.  I might just enjoy my 2nd day off and blow that off.

I had 3 other half marathons I was looking at for October – I passed / missed the Aug 31st deadline to register at cheaper rates but had other things going on.

The race in Valmier, IL is probably going to be along back roads – country roads and is on Sept 27th and I could probably live without that one.  The other two are bigger events  and all held on Sundays – Missouri Cowbell half in St Charles – a really good place to run, I’ve done the Lewis & Clark half marathon there before.  The other two would be the Go! St Louis Half (Halloween edition) the the Rock n Roll St Louis half the following week which I’m already signed up for.

I think I’ll put off any future registration for at least another week, until my Part III exam is over.  I’m sure I’ll do at least one extra half so I can join Half Fanatics.  And, somewhere between now and the end of the year, I need to get a sub 2:30 half marathon to (re)qualify for the Pikes Peak Ascent.  I would like another Platinum trophy so, maybe this month can end the way last month started, we’ll see.  It’s not the end of the world of I don’t get it but I do need to keep running.

October 18th, I test for my next belt in karate – maybe I’ll check that out again tomorrow since I’m blowing off the 50 mile bike race.   Those 4 miles I did this past Wed were kind of sad in terms of performance.  It was my 22nd week in the program but felt more like week 1.  I’ll probably keep my mileage down this week, maybe no more than 3 miles at a time unless I happen to be feeling it and want to run longer.

Part III is the main focus this week.

I have talked with NBS about Part IV reviews already and will be taking that exam in May of 2015.  ….reminds me I have to sign up for the 2015 Lincoln Presidential half yet as well as the Go! which should be taking place the next day – back to back halfs – i like that challenge idea.  🙂

I did get a chance to talk with two other chiropractors who told me they passed part 4 before they passed part 3.  So, however I end up doing next Saturday, I will be giving Part IV a shot next May.  I know I’ve got a really decent shot at getting through this next exam – I know a lot and just need to make sure I don’t have any weaknesses that could hold me back.

It’s odd but, with Part III – one person could score a 70% and pass while another might score a 90% and fail because all 9 sections have to be adequately passed and those sections aren’t fully determined until after the exam is analyzed.

We had a bit over 200 pages of review material in each review session but only a single page for Chiropractic Technique.  It’s almost overlooked but, it does make up a lightly weighted section of the 9 total sections.

Ideally, this will be the plan

  1. Pass Part III (results by Dec)
  2. Obtain License for Illinois
  3. Become Nationally Registered Certified Medical Examiner
  4. Pass Part IV

Somewhere in the midst of #’s 2 & 3 up there I will be eligible to get a job somewhere with someone, at least in the state of Illinois – after passing Part IV – I’ll be able to work anywhere in the country!  🙂   My eyes are wide open at that thought 🙂

 

 

Got G.A.S.? and What you might not know about Michael Jackson

Hans Selye 1907-1982

Hans Selye 1907-1982

…and, of course, by GAS, we’re talking about the General Adaptation Syndrome discovered by endocrinologist Dr. Hans Sylye.  To me, this guy comes across as almost a prodigy and certainly a cerebral powerhouse.  Hans Selye entered a German Medical School in Prague at the age of 17 where he graduated first in his class.  Later he earned a doctorate in organic chemistry.

Bust of Hans Selye at Selye János University, Komárno, Slovakia

Bust of Hans Selye at Selye János University, Komárno, Slovakia

The clinician teaching board reviews, Dr James, had a fun way to describe the GAS and it’s effect on the body by using a somewhat benign example involving a couple who had broken up but are currently at odds and fighting over their DVD collection.   There may be a knock at the door, a fight ensues and the fighting may bring a person from say a calm baseline of zero to an exacerbated 10 on the stress scale.  The thing is, when the fight is over for that day and people go their separate ways, the persons stress level doesn’t necessarily go back down to zero but rather, stays elevated at maybe a 4 or a 5 – kind of ready to jump back into action should the need arise.

"Stress plays a factor or role in any disease"

“Stress plays a factor or role in any disease”

As with many things in life, the stress Dr Selye talks about doesn’t have to be real so, any perception of chronic stress would constitute a state of Alarm which can eventually cause a neuroendocrine response, often from the pituitary which suppresses the thymicolymphaticus system and reduce the resistance of the body to disease.  Other contributing mechanisms would include lymph involution, decrease in WBC, increase in eosinophils, increases in (adrenocorticotropic hormone) and increases in cortisol.

Essentially, with regards to survival, it’s more important to be able to fight off a lion than to fight off a cold which is why immunity decreases in patients with chronic stress.  Dr Selye’s work goes a little beyond the basic flight or fight notion.  As a chiropractor, we learn about Selye because he shows a direct link between the immune system and the nervous system.

I think most people are aware  that we have a brain and a spinal cord.

The brain and spinal cord make up the Central Nervous System

The brain and spinal cord make up the Central Nervous System

once nerves leave the Central Nervous System (CNS) they become part of what’s known as the peripheral nervous system (PNS) and innervate with every organ and muscle in the body.

Peripheral Nervous System (PNS)

Peripheral Nervous System (PNS)

But, there’s also another set of nerves that run parallel to the spinal cord known as the sympathetic chain ganglion which are also known as the intermediolateral cell columns.   I was trying to find a simple picture of the sympathetic chain ganglion.  This was the best I could do for now –

Sympathetic Chain Ganglion with organ innervation

Sympathetic Chain Ganglion with organ innervation

Admittedly, this model is a bit more confusing than the CNS and PNS but it does give a little better idea of how our nervous system controls so many functions and organs of the human body.  The Sympathetic Chain Ganglion in this picture is shown running from T1 to L1 – or from the first thoracic vertebrae to the 2nd Lumbar vertebrae, about the middle portion of your back.    That ganglion of sympathetic nerves and the whole fight or flight system is to the human body what nitrous oxide is to a car.  In a fraction of a second heart rate & blood pressure increase, pupils dilate, sphincter muscles in arterioles that precede capillaries can constrict to shunt blood away from lower priority areas of the body (we don’t care about digesting your food when mama bear jumps out of the woods and attacks you)  smooth muscles in the lungs relax to allow more oxygen into the lungs and so much more – it’s quite a well orchestrated and impressive chain of events.

By the way – that spinal cord is rather small.  Take two of your favorite #2 pencils and put them together, look at the two eraser heads side by side.  That’s about the size of the spinal cord.  It is bigger in some places and smaller in other places but still much smaller than one might imagine.  I never realized the size until I saw it for myself along with transverse sections of the cord during gross anatomy.

I can’t find any pictures online which show with any relativity the transverse size of the spinal cord so, you’ll have to take my word for it.  It’s absolutely mind boggling – the degree to which scientist have dissected that little cord to learn what every little column & tract does and what everything is connected to.

Cross Section of the Spinal Cord

Cross Section of the Spinal Cord

I have absolutely no idea how all of that was figured out but I’m sure it would make fascinating reading 🙂

If you think of a fuse box in your house, it has wires that go from the fuse box to your air conditioner, stove, washer & dryer, the bathrooms, etc.  This is much like the spinal cord which has wires in the form of nerves which go to your arms, legs, fingers, toes and also (as we have seen above) to your heart, lung, kidneys, bladder and reproductive organs.

So, if you come into my office and we want to check the wiring in the posterior columns of your spinal cord we might strike a 512 Mhz tuning fork and press the handle against your big toe since the sensation of vibration is conducted through the wiring of the posterior column.  We may also check two point discrimination and position sense to further evaluate those posterior columns.  Elderly people often lose the sense to vibration first and that has been what I’ve found with geriatric patients I have tested.  It’s all pretty amazing.

Michael Jackson’s Birthday!
michael-jackson-mus-jy-0182_61285906

While I was escaping the realities of my life via blogging it came to my attention that today would have been Michael Jackson’s 56th birthday.  Back in 1982 MJ’s Thriller album was the only album by any artist that I had to buy twice.  At that time the music medium I used was cassette and I played his Thriller cassette so many times that the tape eventually wore out and broke which is why I had to buy a second Thriller cassette.

MJ had a form of Lupus called Discoid Lupus Erythematosus (DLS).  The more common variant people are usually referring to when they mention Lupus is Systemic Lupus Erythematosus (SLE).  The DLS and vitiligo give some insight into some of the changes the public would witness over his lifetime and judge without really known what the heck they were talking about.

Muscle Splinting Psychology & Foot Keystones

An Impetus to Psychological Splinting:
Muscle splinting is a phenomenon where the body will try and protect itself by causing certain muscles to become hypertonic or stiff in order to help protect underlying visceral or somatic tissue.  A couple examples that come to mind would be in the case of appendicitis or whiplash.

Considering appendicitis, when a doctor performs an abdominal exam they will palpate and percuss four quadrants of the abdominal region, in the lower right quadrant is an area known as McBurney’s point which is about 1/2 way between the umbilicus and anterior superior iliac spine (ASIS) or about 2/3rds of the way down for doctors practicing in Europe.  The muscles superficial to the appendix will tighten up to help protect an inflamed appendix and this point will cause pain when palpated in a pt with appendicitis.

McBurney's Point

McBurney’s Point

A similar mechanism takes place in a whiplash patient regarding the muscles around the neck.  Again, the body is trying to protect itself.

As I wake this morning there is a bit more stress and anxiety inherent with another trip and another round of reviews for my impending Part III boards testing.  In the medical community the Part III analog is called Step 3.

Steps 1 and 2 for MDs or Parts I and II for DCs are essentially test which cover basic sciences like chemistry, physiology, anatomy, biochemistry, pathology and the like.  For chiropractors I know Part 1 consist of 9 hours of testing spread out over a two day period of time and part II is a bit longer and also spread out over two days.  Part III is only a 4 hour exam with half given in the first two hours, then a 20 minute break then another 2 hours of testing to finish up.  Part III is more clinical in nature and among other things covers all the basic exams, such as the aforementioned abdominal exam.

I’m not exactly sure why but some things stick very well the first time I hear them while other things take considerable focus and effort to get in my brain.  One thing that stuck when first learning the abdominal exam is a condition known as Caput Medusa.  I guess it has a catchy name that’s hard to forget.  Caput Medusa (CM) is a distention of veins around the umbilicus and although it can be caused by increased pressure in the inferior vena cava the liver is usually what I think of first regarding CM and portal hypertension.

Patient with Caput Madusa

Patient with Caput Madusa

My writing has gone a little tangential but my original thinking was engaged in finding insight into a possible phenomenon I’ll refer to as psychological splinting.  The brain is a visceral organ but instead of thinking in terms of a physical insult or any type of trauma we may also consider psychological insult or trauma and ways we, as humans may and up splinting ourselves psychologically in order to help protect ourselves.

As mentioned earlier, I am currently in a position which allows me an opportunity to use myself as a kind of living laboratory in order to examine my own responses to increases in stress and anxiety.  In order for my brain to help figure out a scientific type allegory I was lead to the concept of muscle splinting and have just started to ponder and consider implications associated with such thinking.

However, I am pressed for time so I’ll have to allocate portions of my four and a half hour trip to Kansas for further evaluation and pondering of psychological splinting.

 

Foot Keystones
There are three arches in the foot; a lateral and medial arch as well as a transverse arch.

Three Arches of the Foot

Three Arches of the Foot

In each of these arches, one bone in each arch acts as a keystone to each arch, the place where maximal stress and load takes place.

In the medial arch the navicular bone is the keystone.  In the lateral arch it’s the cuboid and the transverse arch most commonly has the 2nd metatarsal as the keystone.  An interesting part about this is that those bones, particularly the navicular and cuboid bones are bones that we, as chiropractors, have specifically learned to adjust.

The second metatarsal bone is most common in people with normal biomechanics however that load might also be found on the third or sometimes even as far over as the 4th metatarsal depending on the particular individual.

Morton Neuroma is found along the transverse arch, usually between the 2nd and 4th metatarsal and most commonly between the third and fourth metatarsal.  It is a perineural fibrosis (a thickening of tissue around one of your nerves) and causes nerve degeneration of the common digital nerve.  This usually results in a burning pain (which is common for nerve injuries) and often refers to the dorsal or top surface of the foot.

High heeled shoes have been linked to the development of Morton’s neuroma.  However, it should be noted that when referring to something like high-heeled shoes we come back to a basic situation of altered biomechanics.

One type of psychological splinting discovered for myself. 
Today, it looks like I’ve managed to put off final packing for my trip by writing in this blog so, avoidance may be considered one type of psychological splinting (PS) that I employ in my own life.  Beyond that, however, I’ve taken note of the method employed for my own method of PS which would have to do with reaching out to others and communications.  I would consider avoidance to be a general manifestation of PS while the mode employed i.e., communicating, to be a subset of that general mode.

That insight comes about as a result of recalling that, in the past, when I would be driving to school and have a particularly imposing and intimidating test looming that I would often text my girlfriend at the time and that communication frequency was much higher than normal communications under less stressful circumstances.

As a further offshot and tangent, I know have to wonder if the artificial manufacturing of stressful situations in a coupled relationship is done so that increased communications does take place and as such may be somehow perceived as a benefit to the one who might instigate say, an argument when no perceivably real genesis for an argument or altercation exist to begin with.

 

Reference: for those interested in some of the neuromusculoskeletal (NMS) aspects of Muscle Splinting:  The role of autogenic inhibition in the reduction of muscle splinting by Herbert Miller, PhD

W11D3 – Cooked @ 104 Degrees For 3 Miles & Week 9 Weigh-In

In this blog
 – Week 11 Day 3 training run – cooked at 104 degrees for 3 miles
 – Week  9 Weigh-In
 – Instagram
 – Future Miles
– 2 New Upcoming Races
– Part III Boards

 

Week 11 Day 3 TRAINING RUN – COOKED AT 104 DEGREES FOR 3 MILES

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After yesterdays difficult run in the 99 degree heat and getting up too late to beat the sun I figured I would run at night after the sun went down.  However, I finished up my lawn jobs by 12:30 and had until 3 p.m. before I needed to be at my other job and knew that the more I put off what I needed to do the greater the likelihood that it might not happen.  I was more afraid of missing today’s run than I was of dealing with the heat.

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I fortified at a convenience store with 2 liters of water and a couple bottles of vitamin water, then I picked a park with a LOT of trees 🙂

The sun was even nice today due to a bit of cloud cover

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Still, there was a heat index of 104 so I ended up taking this run in 10 minute increments.  I jogged 9 min, walked 1 then jogged 8, walked 2 then jogged 7 and walked 3.  After that the heat was a bit much and I ran what I could to finish out my run.

I was also fortunate that today was a short run of only 3 miles.  Saturday will be 5 so, I might want to get out around 5:30 when the sun is first peaking out and not at full strength.

WEEK 9 WEIGH-IN
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My 1 week post weight-loss contest weight of 260 lbs is still being maintained.  I’m not exactly sure how I feel about this.  On one hand, after starting the year out at 316.2 pounds and maintaining the gist of my weight loss for over two months after that contest is a very good thing but, I also know I could be a lot better runner if I was lighter.  The other thing I consider is the stress associated with eating less and dropping weight and knowing I’m already taking on a lot of new stress from the big increase in training from Week 11 onward.

The nagging feeling is that I may be selling myself short and not doing enough.  Just kidding myself that my current efforts are good enough.  Perhaps it’s a standard dichotomy of emotional feedback inherent with desires and efforts towards improving oneself as contrasted with self doubts and being more attuned and used to being where we are in life as opposed to some future improved self which has not yet arrived.

INSTAGRAM 🙂
The “View on Instagram” button is something new.   I got the code from the Instagram website and it should link directly to my Instagram account in case there’s anyone that would like to help encourage me along my current journey to my third marathon pursuit.

Instagram

There are some amazing people on instagram.  On lady I’m following is from Columbia and goes by the name of @fibrofree

She has a website at http://www.ironsoul.com  This person has gone from dealing with cancer, fibromyalgia, depression and other pains to become a triathlete.

Another guy I like to follow is @matthewabitbolracing who lost 100 lbs of bodyweight then proceeded to run 41 marathons with a PR of 2:54:18 and 56 Half Marathons with a PR of 1:21:48.  He’s also completed 5 Boston Marathons.

I’d like to join Matthew in that Lost 100 lbs club 🙂

FUTURE MILES
I’ve filled out my spreadsheet with projected training runs and have been looking at the mileage increase from month to month as shown below

Month – Distance
April – 59 miles
May – 50 miles
June – 49 miles
July – 92 miles
Aug – 140 miles
Sept – 153 miles

April was a little high on mileage due to running two half marathons that month.  I’ll certainly tack on a mile somewhere this month to get my NikePlus gold 50 mile trophy.  July is an increase of 88% in mileage and August is another jump of 52%

That 88% mileage increase in July has caught my attention.  That averages out to about an extra 22% increase per week which is about double the recommended 10% increase per week I’ve always read about.  I’ll have to view the scheduled 92 miles in July as my new starting level and all the previous work as a buildup.  Part of the reason for the huge % increase is because all the runs prior to Week 11 have been based on time and, I’m pretty slow so the first 10 weeks have been low mileage.

July will be about an extra 10 miles away but, that’s on average and there is a slow build up of 1 to 2 miles per week starting from Week 11 with an initial weekly mileage base of 15 miles.  I think I can do it.  I keep recalling a couple years ago when I would head out with my girlfriend and we could knock out up to 10 miles without any formal training at all.  This Saturday’s long run is only 5 miles and it’s not until Week 20 when my long run is 10 miles.  I’ll probably keep reading up in Jeff Galloway’s book called Marathon – You Can Do It which is the same book I used 20 years ago to complete my first marathon.  For long runs below 18 miles he advocates walking 1 minute after every 5 minutes of jogging.  For runs of 18-20 (maybe he meant 22) miles he says 1 minute walking for every 4 minutes of jogging and for runs 23 to 26 miles 1 minute of walking for every 3 minutes of jogging.

I’ll have to play this by ear but I have to get my miles in so, whatever it takes.

2 NEW UPCOMING RACES

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I’m signed up for back to back races on the 28th & 29th of this month.  The 28th is the Macklind Mile.  I talked to a guy on the shuttle that took us back to the start of the Go! St Louis All American 5k last week and he really talked the race up.  It’s a 1 mile race and I’ll be running in the Family & Friends division which will not rank me against other men or men in my age division but will still give me a time so, I’m guaranteed to get a new PR here because I’ve never done this race distance before 🙂  The Macklind Mile also has swag which includes the coveted 1.0 Mile sticker which, is actually a distance I can cover!  🙂

 2014SLFR-PRIDE5K

On Sunday morning is a Pride 5k Run which includes medals.  I chatted with the race director about this race.  Originally they had medals available for the first 300 finishers but, that number has been upped to 400 medals and they are expecting 400-500 people so ….I have a decent chance of getting a medal since there are walkers and people who don’t show up.  I might have to edge my way towards the front of the pack to help make sure i finish quickly enough to get a medal.  My hope here is to better my last 5k time and get one of those medals!  🙂  I guess this is a gay & lesbian sponsored type of run so, the medals should be colorful 🙂

PART III BOARDS
Hotels are booked for Iowa & Kansas!  Days off have already been requested from work.  Still need to give NBS a call to register for these reviews as well as for Chesterfield, MO.  I’m kind of shaking my head here – confidence isn’t as high as I would like.  I’m reading a ton but I know I have to learn 100 things in any given part in order to eventually answer 4 questions so I know ….well, i don’t know.  There isn’t a heck of a lot of time left, one full month of self study in July and a lot of board reviews in August.  I get a very sick feeling in my stomach just writing about the upcoming exam.

idk – this is a monster i have to deal with on my own.  i have to figure something out and i have to pass this exam because i don’t have much of a future without getting a license.

Corrections for Bob – Vietnam Vet

In a previous blog I mentioned a patient of my brother’s who was taking over 200 prescribed pills a day and cut that number down to around 50 after seeing my brother for chiropractic care.

I spent a significant amount of time with my Dad and brother tonight (Cards vs Washington baseball game) and after the game we talked a lot and I have a much more accurate recount of an amazing Vietnam veteran named Bob.

This was in the mid 2000’s, maybe around 2008 when my brother’s wife took over main operations at Vitalize Chiropractic.  They had an ad in the paper which generally stated, “Let Our Office Be Your New Hope”

Bob saw that ad.

Bob had to have one of his lungs removed due to his exposure to Agent Orange in vietnam, he also had such bad pain in his legs that the only solution his doctors had for him was to severe his spinal cord around L4.

L4 is at your lower back and the nerves that come out of that region and below go to, among other places …. your legs.  So his option was to have his nerves cut and voluntarily become paralyzed from the waist down.  He wouldn’t be able to walk any more but, that was the last option he was given to get out of pain.

Bob was at the point of committing suicide and on his birthday he received a letter informing him that a good friend of his from the war actually did commit suicide.

Given the choices between killing himself, becoming paralyzed or checking out this ad that said let our office be your new hope …. he decided to check out the chiropractic route.

By the time Bob made it into my brother’s office his life consisted of taking 57 different prescription medications which amounted to 221 pills every day of his life.  After receiving adjustments from my brother and his wife for one year, Bob was down to 28 medications and less than 110 pills per day.

That’s a little better than a 50% reduction both in the number of medications and pills not to mention the fact that he was out of pain enough that he thwarted other doctors recommendations to have his spinal cord cut to get him out of pain which meant he was still walking.

Due to all the medications, his driving was impaired at times and at one time he did get pulled over and arrested for impaired driving.

Bob went to court and fought for one thing.  He fought to be allowed to drive to his chiropractors office, that was the only thing he asked for.  After telling his story to the judge and explaining his life changing results, he was granted the right to drive to my brother’s office to get adjusted, only to my brother’s office and only during daylight hours.

There’s a lot of stories like Bobs out there.  The lady I helped with hypervagal tone was my first exposure to these kinds of benefits with chiropractic.  These are people who suffered decades before experiencing relief.

Can you imagine losing your right to drive and having the one thing you fight for to be going to see your chiropractor?  It kind of shows also the respect that must be given to our men and women in the armed forces and especially to our veterans.  On one hand you could consider yourself lucky to make it through a war alive but, here’s a guy that did then spent most of the remainder of his life after serving his country suffering up until the point he started getting regular adjustments.

For any readers not familiar with chiropractic you should probably know that it takes one additional year of schooling to become a DC (chiropractor) than it does to become an MD and there are no shortage of pushes to get chiropractic absorbed in with the traditional medical professions much as already happened with osteopaths (DO’s)

But, there are some things traditional medicine isn’t able to fix.  Anyway, that’s the correction and update pertaining to Bob.  The exact numbers of medications and pills both before and after a year of treatment is something I wasn’t fully accurate with in my previous post and, a lot of the other details I shared were just learned tonight.

Bob did finally pass away on July 21st, 2012.  One of Bob’s daughters called my brother to express her gratitude in helping to change his quality of life so dramatically over his final years.   My brother happened to be in Bob’s “top 5” on his phone which is one of the reasons he got contacted.

oh, one other thing I remembered.  My brother also mentioned that prior to his chiropractic treatments, Bob was taking so much liquid morphine to help control his pain that it was enough to kill three grown men.

….

In other news – the St Louis Cardinals spanked the Washington Nationals tonight by a score of 4 to 1 just as they did by beating them last night by a score of 1 to 0

I do believe Washington was on a bit of a roll before having to face the Cardinals …not unlike Toronto which was on a heck of a roll before having to face the Cardinals and getting spanked as well 😉

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We had a great time and it was a really nice way to kick off Father’s Day with our dad.  I also remembered from my follies the last time we were all at the ballpark and only ordered ONE Crown Royal & 7-up.  There may have been one other crown & 7 waiting for me when I came back from the restroom one time but, that was it and nothing but easy to handle beer after that 😉

Running…. well, last night’s evening run got preempted by the impromptu baseball game and I was signed up for a 5k Father’s Day run which I would need to be at by 6:15 a.m. to pick up my race packet.   …well, the Cardinals probably have a better chance of getting back into the World Series this year than of me getting up in 4 hours …ya never know but, I will get my last official run of week 10 in tomorrow.  Come to think of it, I already did four runs this week since I snuck that extra run in on Tuesday but, that wasn’t really part of the program.

Week 10 ends my runs based on time.  Starting next week, in Week 11, the scheduled runs are all based on miles….